NHS performance summary: November-December 2020

Our monthly round-up of the latest NHS performance data.

Latest data

Published: 14/01/2021

Today, NHS England and NHS Digital published the latest data on key activity and performance measures for November and December of last year. Urgent and Emergency Care Daily Situation Reports were also published for the first week of January, giving a more up-to-date analysis of how the NHS is coping this winter. Here we show some of these statistics and how they compare with previous trends.

During this unprecedented time for the health service, QualityWatch continues to provide independent scrutiny of the health and social care system as far as possible. The most recent data published today reflects changes in access and service use as a result of the coronavirus (Covid-19) pandemic. In light of these shifts in activity, we have added new charts and changed the presentation of some of our usual charts, to aid interpretation. It is also worth noting that NHS England have suspended data collection for 2020/21 for some of their performance statistics, including delayed transfers of care.

In March 2019, the Clinically-Led Review of NHS Access Standards Interim Report was released, proposing some significant changes to many of the targets reported on here. A six-month Progress Report from the NHS Medical Director was also published in October 2019. Field testing of the proposed new standards began in 2019, however due to the coronavirus (Covid-19) outbreak, the publication of the review’s recommendations has been delayed until later this year.

For urgent and emergency care, the field test sites have not been submitting four-hour performance data since May 2019. The time series presented here excludes the field testing sites and so is comparable across months and years. For elective care, performance of the field test sites will continue to be included in the national time series, so the data is fully comparable over time.

For interactive charts showing the quality of health and social care over time, please refer to our 200+ indicators.

Urgent care

  • In December 2020, total A&E attendances fell to just under 1.5 million – 32% lower than in December 2019. This follows a decrease to 916,581 in April 2020 and a subsequent increase to just over 1.7 million in August 2020. Around 1 million attendances in December were to major (type 1) A&E departments.
  • There were 356,505 emergency admissions via A&E in December 2020 – 16% lower than in December 2019. Emergency admissions via A&E have generally been increasing year-on-year, but fell dramatically in April 2020 to 257,928.
  • In December 2020, one in five people (20%) attending A&E spent more than four hours from arrival to admission, transfer or discharge, approximately the same as in December 2019. Waiting times have worsened for the past seven consecutive months.
  • 89,807 patients spent more than four hours waiting on a trolley from a decision to admit to admission in December 2020 – 9% lower than in December 2019. Trolley waits have been increasing each month since May 2020. 3,745 people had a trolley wait of over 12 hours in December 2020, the highest number since records began.
  • There were over 1.7 million calls made to NHS 111 in December 2020, 5% lower than in December 2019. For the past four consecutive months, there have been more calls made to NHS 111 than A&E attendances.

For more information, see our A&E waiting times indicator.

Ambulance handover delays

  • In Week 1 of 2021 (commencing 4 January), 14,780 ambulances experienced a handover delay of over 30 minutes, 19% lower than in Week 1 of 2020. Of these, 5,513 ambulances experienced a handover delay of over 60 minutes, the highest number since the data has been published.

Bed occupancy

  • General and acute bed occupancy was 89% in Week 1 of 2021. There was an average of 90,885 general and acute beds available each day – 6% fewer than in Week 1 of 2020.
  • In Week 1 of 2021, the average number of adult critical care beds available each day was 5,135 – an increase of 16% compared to the average of weeks 51 to 53 of 2020. The average of weeks 51 to 53 was taken to allow for comparison to previous years when no week 53 occurred.
  • 83% of available adult critical care beds were occupied in Week 1 of 2021. Due to increased demand for critical care beds, additional beds have been opened in the winter of 2020/21. Relative to the number of available adult critical care beds in Week 1 of 2020, 117% of beds were occupied in Week 1 of 2021.

Treatment and diagnostic test activity and waiting times

  • In November 2020, there were over 1.6 million first outpatient attendances for general and acute specialties – more than double the low of 783,259 in April 2020 but 18% lower than in November 2019. The number of elective admissions decreased to 588,345 – 21% lower than in November 2019.
  • The number of GP referrals to general and acute specialties decreased to 816,420 in November 2020, following the recent fall to 257,850 in April 2020 and subsequent increase to 871,643 in October 2020.
  • The total number of people waiting to start consultant-led elective treatment increased to over 4.5 million in November 2020 (reported waiting list plus the estimate of missing data). This follows a previous fall to 3.9 million in May 2020.
  • The number of people waiting over 52 weeks to start consultant-led elective treatment increased to 192,169 in November 2020, the highest level since April 2008.
  • In November 2020, 32% of people waiting to start elective treatment had been waiting over 18 weeks – a slight improvement compared to October 2020. The 18-week target has not been met for over four and a half years.
  • 28% of patients had been waiting over six weeks for a diagnostic test in November 2020. The diagnostic waiting time target has not been met for seven years.
  • For fifteen common diagnostic tests, including non-obstetric ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT), there were 1,200,252 tests carried out in November 2020. This follows a previous fall to 838,569 in March 2020 and subsequent increase to 1,239,114 in October 2020.

For more information, see our treatment waiting times and diagnostic test waiting times indicators.

Cancer waiting times

  • 205,182 patients had a first consultant appointment for suspected cancer in November 2020 following an urgent GP referral – 2% higher than in November 2019. This follows a substantial drop to less than 80,000 first consultant appointments in April 2020.
  • In November 2020, almost one in four patients (24%) waited longer than two months to start their first treatment following an urgent GP referral for suspected cancer. The 62-day cancer target has not been met for over four and a half years.
  • The percentage of patients who waited longer than two months to start their first treatment for cancer following a referral from a national screening service decreased to 12% in November 2020, following the recent worsening to 87% in June 2020. The waiting time target has not been met for over two and a half years.
  • 1,337 people started a first treatment for cancer in November 2020 following a referral from a national screening service – 29% lower than in November 2019.

For more information, see our cancer waiting time targets indicator.


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